Grey-faced patients barely respond to the doctors and nurses treating them in intensive care at the North Estonian regional hospital.

Dr Katrin Sikk, a neurologist, says many of her patients are here because of alcohol.

"They have seizures or are suffering severe withdrawal symptoms, or they've suffered a trauma," she says.

The long-term problems include paralysis and brain damage, people injured in drunken accidents and car crashes, or those who have simply drunk themselves into a coma.

Heavy drinking is widespread in Estonia, which comes near the top of European Union rankings for alcohol consumption. Consumers are now free to choose from a huge variety of brands - a dramatic change since Soviet times.

On average each Estonian drinks 12 litres of pure alcohol each year - and every year they are drinking more. Experts say alcohol kills between 1,500 and 2,000 people a year - in one of the EU's smallest member states.

Some warn that if the trend continues, alcohol will contribute to an irreversible population decline.

Targeting youths

The tax hike may sound like good news, but anti-alcohol campaigners say it is unlikely to help.

While I welcome the tax rise, alcohol is so much cheaper now that I don't think it's significant

Lauri Beekmann, anti-alcohol activist

The government, they say, has kept taxes low for years to boost economic growth, despite rising alcohol consumption. They argue that it is only raising taxes now because it is not planning to join the eurozone soon, so it is no longer worried about a tax rise pushing up inflation.

Alcohol, say the campaigners, has in fact got cheaper in recent years, so the rise will not stop people drinking.

A leading anti-alcohol activist, Lauri Beekmann, runs the Estonian Temperance Union. He showed me round a brightly painted cellar cafe in central Tallinn - one of the union's newest projects.

It is an alcohol-free cafe for young people - an attempt to persuade them that they can have a good time without drinking.

Lauri says Estonian youths are not only dying in drink-driving accidents, but when drunk they're putting themselves at risk of HIV/Aids by having unprotected sex. HIV is spreading faster in Estonia than in almost any other European country.

Big business

Despite some local bans on night-time alcohol sales, Mr Beekmann is damning about the government's reaction to the alcohol problem.

Estonian drinks firms are in fierce competition with EU rivals

"It is ignored," he tells me. "Sometimes politicians talk about it, but almost nothing is done. There is no ban on advertising or sponsorship by drinks manufacturers, and while I welcome the tax rise, alcohol is so much cheaper now that I don't think it's significant."

At the ministry of social affairs, they are barely more optimistic.

Chief public health officer Andrus Lipand says the government asked for a national alcohol strategy, but his proposals to limit sales and advertising are simply being ignored. Shops are keen to continue their profitable late-night alcohol sales.

"Our government supports a so-called liberal alcohol policy. It's a conflict between health and business, and at the moment business is winning," says Mr Lipand.

Booze cruises

Yet the Estonian tax hike has been welcomed on the other side of the Baltic Sea, by the Finnish government.

When Estonia joined the EU in 2004, the Finns, worried that people would travel to Tallinn to buy cheap liquor, cut their own alcohol tax by more than 30%. But the plan did not work. Finns just started drinking more. Hundreds of thousands of them catch the ferry from Helsinki to Tallinn and return home with crates of cheap booze.

In the last three years there has been a sharp rise in alcohol-related diseases and crime in Finland, and drink has become the country's number one cause of death among adults.

Now, encouraged by the Estonian tax rise, the Finnish government has announced that taxes will go up there too - by 10% on beer and 15% on spirits.

Shoppers on one weekend ferry had mixed feelings about the rise. Some wanted to see an altogether more liberal alcohol policy in Finland, while others said they were worried about heavy drinking in Finland - but none of them thought it would stop them shopping in Estonia. One told me that if the price got too high, he would just go to nearby Latvia instead.

Frustrated Finns

Finland has traditionally had very strict controls on alcohol. Strong drinks can only be bought in the state-controlled Alko shops - rather uninviting buildings which have few signs outside advertising their wares.

At the Finnish health ministry Ismo Tuominen, in charge of devising new alcohol legislation, says the 2004 tax cut was a mistake - but that Finland is helpless to tackle its growing alcohol consumption.

"EU legislation is at the root of our problems," he says. "They treat alcohol like an ordinary product, like tomato ketchup or milk. They have to allow us to develop a health-based policy on alcohol - so we can limit the now limitless possibilities to bring alcohol in from other EU member states."

He accepts that that seems unlikely, as many EU countries are seeing a decline in alcohol consumption, and many others, Estonia included, profit from the international trade.

For now, it seems Estonia and Finland are going to have to try to discourage their people from drinking at home - and hope that the measures don't simply encourage more shopping trips abroad.